Recommendation	Comments
Prioritize: Prioritize what you want to accomplish during the discussion	Ask yourself: What are two to four key points that the patient should retain? What decisions should be made during this encounter? What is reasonable to expect from the patient during this encounter?
Practice and prepare: Practice giving bad news; arrange for an environment conducive to delivering the news	Rehearse the discussion; arrange for a private location without interruptions; set cell phones and pagers to vibrate or turn them off; ask the patient if he or she wants to invite family members
Assess patient understanding: Start with opening questions, rather than medical statements, to determine the patient's level of understanding about the situation	Ask the patient: “What do you already know about your condition?” “What does it mean to you?” “What do you think will happen?”
Determine patient preferences: Ask what and how much information the patient wants to know	Assess how the patient wants the information presented; ask the patient, “Some of my patients prefer hearing only the big picture, whereas others want a lot of details. Which do you prefer?”
Present information: Deliver information to the patient using language that is easy to understand (do not use medical jargon); provide a small amount of information at a time; check periodically for patient comprehension	Provide a few pieces of information, and then ask the patient to repeat it back to you
Provide emotional support: Allow the patient to express his or her emotions; respond with empathy	Assess the patient's emotional state directly and often (ask the patient: “How are you doing?” “Is this hard for you?” “You look frustrated/disappointed/angry—is that true?” “Let me know when we should continue”); use nonverbal cues such as eye contact; listen to what the patient says and validate his or her reactions with empathic statements such as “I understand that this is very difficult news.”
Discuss options for the future: Devise a plan for subsequent visits and care	Help the patient understand the expected disease course and how the disease may or may not respond to treatment; schedule follow-up visits (ask the patient: “Can we meet next week to discuss treatment options and any questions you may have?”)
Offer additional support: Provide information about support services	Bring handouts and pamphlets to the visit; refer the patient to support groups, psychologists, social workers, or chaplains
Consider individual preferences: Assess patient preferences, and tailor the discussion appropriately	Consider the patient's sex, age, health literacy, health status, previous health care experiences, social status, culture, and race/ethnicity; avoid assumptions about what the patient is likely to want; ask the patient directly about values and preferences